Endoscopy Exam Notes PDF

# Endoscopy Exam Notes ## What is Endoscopy? - Endoscopy is a procedure used to view and operate on the internal organs and vessels of the body. - Endoscopy is not only used for the digestive system. - It has a wider scope ## When an Endoscopy is Used: - Investigate unusual symptoms. - Hel...

# Endoscopy Exam Notes ## What is Endoscopy? - Endoscopy is a procedure used to view and operate on the internal organs and vessels of the body. - Endoscopy is not only used for the digestive system. - It has a wider scope ## When an Endoscopy is Used: - Investigate unusual symptoms. - Help perform certain types of surgery. - An endoscope can also be used to remove a small sample of tissue for further analysis. ## Investigating Symptoms Are: - Vomiting blood - Persistent diarrhea - Difficulty in swallowing (dysphagia) - Persistent abdominal pain - Chest pain, that is not caused by heart-related: persistent vomiting - Unexplained weight loss. ## Types of Endoscopy 1. Laproscopy for abdomen or pelvis. 2. Hysteroscopy for uterus 3. Cystoscopy for bladder 4. Gastroscopy (upper GI endoscopy) 5. Colonoscopy for colon 6. Sigmoidoscopy 7. Endoscopic Retrograde Cholangiopancreatography (ERCP). 8. Bronchoscopy for lungs 9. Laryngoscopy 10. Arthroscopy for joints 11. Nasopharyngoscopy 12. Otoscopy for ear ## Why Endoscopy? - It’s used for diagnosis and treatment. - Source of bleeding - Polyps (group of abnormal tissues) - Inflammatory bowel diseases ## Advantages: - The endoscope is much less invasive than open surgery - Allows for descriptive and photographic documentation - Low morbidity and mortality ## Disadvantage: - It can only see the surface of the organ - It can only view a small area at a time ## Latest Techniques in Endoscopy 1. **Capsule endoscopy:** A capsule with a tiny camera is swallowed that transmits the images as it passes through. 2. **Endoscopic retrograde cholangiopancreatography (ERCP):** Endoscopy and X-ray are combined to treat pancreatic and bile diseases. 3. **Endoscopic Ultrasound:** High-frequency sound waves are used to identify the digestive system and lung diseases. 4. **Narrowband imaging:** Filtered light is used for better visualization of internal organs. 5. **Chromolendoscopy:** Dyes are installed before endoscopy to identify any lesions. ## How Capsule Endoscopy Works - It is the latest technique that uses small-sized video capsule to examine digestive tract and stomach area. - Sensors are attached on the chest. - Data is recorder attached to a belt around the waist. - The recorded images are displayed on the computer. - The capsule is naturally passed from the body. - It last for about 30-60 mins. - Eat and drink no less than 12 hours before the procedure. - No strenuous activity but the procedure. - **NB:** Is for small intestine (Co). - Insufflator introduces gas. - The abdomen is inflated by pumping CO2 gas into the abdominal cavity between the visceral and parietal leaves of the peritoneum. - The abdominal wall is tightened to provide the necessary space for image and manipulation during laparoscopic intervention. # Endoscopy B ## Da Vinci Surgical System - Da Vinci offers (Robot Assistance) for GERD, Suyeno, etc. - Improved dexterity - Better Control - Better precaution ## Advantages: - Reduced hospital stay - Less staff required - Less risky ## NB: There are some limitations: - Endoscopy is typically used to: - Inflammatory bowel diseases (IBD), such as: ulcerative colitis (UC) and crohn’s diseases. - Stomach ulcer - Chronic constipation - Pancreatitis - Gallstones - Tumors - Infections - Hiatal hernia - Blood in your urine - Unusual vagina bleeding (GERD) - Gastroesophageal reflux diseases - Unexplained bleeding in digestive tract - Blockage of the esophagus ## Types: - Upper GI endoscopy (GERD) - Enteroscopy - - Colonoscopy - DX of Endoscopy - Superior to radiology - Except for motility disorders ## Take Biopsies ## Explain Cause of Pain: - Reflux Oesophagitis - Ulcer disease - Esophagus to jejunum - Malignancy ## Therapeutic: - Hemorrhage - Injection - Clips - Removal of foreign bodies - Dilation of strictures - Stenting - Feeding (PEG) - Percutaneous Endoscopic Gastrostomy # Endoscopy B1 ## Small Bowel Enteroscopy ### Indications: - GT bleeding of obscure origin - Chronic diarrhea - Malabsorption syndromes - Chronic abdominal pain ### Therapeutic Application: - Foreign body removal - Mucosal resection - Insertion of SEMS (self-expandable metal): - Dilation of stricture in Crohn’s disease - ERCP after brillroth, Li or Roux-en-Y reconstruction after bariatric surgery ### The Sort of Conditions That Can Be Confirmed or Ruled Out Include: - Inflammation of the gullet (oesophagus), called oesophagitis - Redness is seen in the area on the lining of the oesophagus, stomach and duodenal ulcers - Small, red crater is seen inside the lining of the stomach or duodenum. - Inflammation of the duodenum (duodenitis) and inflammation of the stomach (gastritis). - Stomach and oesophageal cancer - Various other rare conditions ## Why Is Gastroscopy Useful? - Is a valuable diagnostic tool that allows doctors to closely examine the upper digestive tract. - Detailed visualization - Tissue samples and photography - Symptom investigation - Ulcer detection and infection - Biopsy for precise diagnoses - Early cancer detection # Endoscopy C ## Gastroscopy - Summary: gastroscopy provides a reliable way to diagnose conditions, such as ulcers, infection, cancer, supporting tailored Rx for each patient. - Its useful for - Diagnosing - Understanding the underlying cause of indigestion and related conditions ## Is Gastroscopy Reliable? - Gastroscopy is a reliable test for identifying abnormalities in the upper digestive tract, such as inflammation, ulcers, tumors, and provides a clear view of the esophagus, stomach, and duodenum. - However, it’s not completely foolproof (means that while gastroscopy is generally effective, it is not guaranteed to detect every abnormality, particularly in very early or subtle cases. Certain conditions like: tiny ulcers or early-stage cancer, might go undetected). ## Colonoscopy - Into large intestine, through the anus, to ileocecum to inspect the entire colon, the examiner looks for any abnormalities or pathologies within the mucosal lining. ### (i) Procedure Effectiveness: - However, certain anatomical challenges, such as a mobile or elongated sigmoid transverse colon, and post surge adhesions can make the procedure more difficult. ### (ii) Duration and Discomfort: - Usually 30 minutes - Training and skill ### (iii) Diagnostic and Therapeutic Capability: - (like reasons for colonoscopy) ## Colonoscopy Indications: - Constipation - Diarrhea - Abdominal pain - Postpolypectomy surveillance (prevention/aftercare colorectal carcinoma): - Bleeding per rectum, unexplained anemia, weight loss. - Pathological thickening of the colon wall detected by other imaging procedures - Primary tumor search with metastatic malignancy. # Endoscopy CA ## Colonoscopy: Contraindications ### General Indications - Perforated intestine - Acute diverticulitis (small pouches in the colon) - Deep ulceration - Severe ischemic necrosis - Fulminant colitis (it affects the whole system) - Cardiopulmonary decompensation ### Complications and Risks: - Risk of perforation - Injury to blood vessels causing bleeding - Infection - Comparing diagnostic and therapeutic colonoscopy, more complications arise from therapeutic measures, such as polypectomies. ## 5 Basic Rules of Colonoscopy: 1. Do not advance the endoscope without a clear view of the lumen. 2. Do not advance the endoscope when in doubt, pull back. 3. When in doubt, pull back. 4. Use as little air as possible and as much air as necessary. 5. Pay attention to patients’ pain reaction. ## Procedure Description: - Schematogram of large intestine - Potential difficult segments during the procedures. - Red dotted circle: - Rectosigmoid junction - Sigmoid descending - Splenic flexure - Hepatic flexure - Green dotted box: - Sigmoid colon ## Pre-Intubation: - Pts on left lateral decubitus position with knee bent and pulled up. - Inspection of the region: - Skin tags, scarring, and fistular tissues, hemorrhoids and prolapse - Digital rectal examination with topical anesthetic jelly (usually lidocaine jelly): - To prelubricate the anal canal - To relax the sphincters # Endoscopy D ## Anal Canal - Very short segment (2-3 cm) from the anal verge to the dentate line. - Introduction of the colonoscope, a red-out sign occurs: scope is opposed to the colon mucosa, thus inflate an in the anus using air/water infusion valve button. - Retroflexion is done later once the scope has been withdrawn to the level of the distal rectum ## Terminal Ileum - Seen on the left part of the scope. - Usually closed, To open the entrance, deflect its tip to pass thin, it’s a repeated approach the ICV while using air suction. - Progression will give a red-out sign followed by the visualization of the TI. ## It Has Characteristic Villi - Water-filling (T) - Indigocarmine-dye (I) - Narrow-band imaging mode ## Pathology of the Colonoscopy - Diverticulosis - Diverticulitis - Polyposis - IBD: Crohn's, ulcerative colitis - Angiodysplasia and radiation colitis - Pseudomembranous ischemic colitis ## Anotes: - Halitosis (bad breath) - Enteroscopy and its types - Protoscopy AKA rectoscope, purposes and procedures being established ## Enteroscopy - A procedure used to examine deeper parts of the small intestine that cannot be accessed by a standard gastroscope. - Purpose: Dx and treat conditions in the small intestine, such as bleeding, tumors, or inflammation - Perform biopsies or remove polyps ## Types: - Capsule Endoscopy - Double-Balloon Enteroscopy - Focus area: Small intestine beyond the duodenum # Endoscopy E ## Uses (Therapeutic) of Bronchoscopy: - Insertion of an endotracheal tube for general anesthesia in pts in whom extension of neck maybe dangerous. - Tamponade of endobronchial bleeding, either with end of bronchoscope itself or by using a fogarty or other balloon catheter. - Brachytherapy: “A seed” is placed into the lung where it lets off radiation killing local cancer cells. ## Complications of Bronchoscopy: - Pneumothorax - Hemorrhage - Hypoxaemia - Bronchospasm in asthmatic - Complications of sedation (local anesthesia) (epileptic seizure, cardiac dysrhythmias, hypoventilation, laryngospasm) - CVS problems - Uncorrectable bleeding tendency - Tracheal stenosis - Uncorrectable bleeding tendency - Uncorrectable bleeding tendency - Poorly controlled asthma. - Infection Control - Protection of instruments - Protection of staffs - Protection of patients ## Preparation - Pts should fast 6-12 hours and no drinking any liquids the previous day. - Should avoid smoking for 24 hours - Should avoid taking any aspirin or ibuprofen type medicine (anticoagulants) - After bronchoscopy pulse should take the vital signs. - No food/drink for about 2 hours after. ## Bronchoscopy Treatments: - Stent therapy - Laser therapy - Argon beam coagulation - Brachytherapy - Rigid bronchoscopy ## Contraindication of Bronchoscopy: - Uncorrectable hypoxemia - Hypercapnia - Unstable myocardium # Endoscopy E1 ## Risks for Bronchoscopy: - Use of bronchoscopy mildly irritates the lining of the airway. - It results in some swelling and inflammation. - As hoarseness caused from abrading the vocal cords. ## Gallstones: - Gallstones that form in the gallbladder and become stuck in the ducts. - Inflammation due to trauma/illness, such as pancreatitis. - Dysfunction of valve in the duct, called sphincters. - Scarring of the ducts (Sclerosis) - Pseudo-cysts – accumulation of fluid and tissue debris. ## Therapeutic Indications: - Sphincterotomy - Stone removal - Stent placement - Balloon dilation - Tissue sampling ## Preparation for ERCP: - The pt’s upper GI must be empty. - Generally no eating/drinking is allowed 8 hours b4 ERCP. - Removal of dentures, jewelry or contact lenses before the procedure. ## Diagnostic Uses: - Used when it is suspected a person’s bile (pancreatic duct) may be narrowed or blocked due to: - Tumors - Infection - Lower tumors arise along the bile duct, that enter the lower bile ducts but not inside. The lower ## Procedures ERCP: - Local anesthetic sprayed on the back of the throat and IV sedative like on their back/side on an X-ray table. - Endoscopy is inserted throughout the mouth, down the esophagus, into the stomach, through the pylorus into the duodenum where the ampulla of vater exists. ## After the Procedure ERCP - Pts are monitored in the endoscopy area for 1-2 hrs until the effect of the sedatives have worn off. - Eating and drinking is allowed if the throat is no longer numb. - If a gallstone was removed or place a stent during the test, the pts. Is made for hospitalization over the night. ## Significant Risks Associated with ERCP: - Infection, pancreatitis, allergic to sedative - Excessive bleeding (hemorrhage) - Fine puncture of the GI tract/duct - Tissue damage from radiation exposure - Death (rare circumstance) ## Another Name for Pancreatic Duct: - Wirsung ## Complications of ERCP: - Complications can occur in approximately 1 to 5 percent depending on the skill of the physician and the underlying disorders. ## Contraindications of ERCP: - Unstable cardiopulmonary pts. - Unstable neurological problem - Psychological problems - Existing bowl perforation - Structural abnormalities of the esophagus, stomach, or small intestine. - An altered surgical anatomy - ERCP with sphincterotomy or ampullectomy is relatively contraindicated in coagulopathic pts. # Endoscopy G - When does the patient require cystoscopy? - Frequent urinary tract infections - Blood in the urine, which is called hematuria. - A frequent and urgent need to urinate - Unusual cells found in a urine sample. - Painful urination, chronic pelvic pain. - Urinary blockage caused by prostate enlargement or some other abnormal narrowing of the urinary tract. - A stone in the urinary bladder. - An unusual growth, polyp, tumor, in the bladder. # Endoscopy FI - Proctoscopy - A procedure to examine the rectum and the anal (anus) canal using a short, rigid instrument called a proctoscopy (lower 10-15 cm long of the gastrointestinal tract). ## Purpose of Proctoscopy: - To detect diseases of the rectum or anus. - To evaluate abnormal results of a barium enema. - To look for causes of rectal bleeding. - To monitor the growth of polyps (benign growths on the lining of the intestine). - To check for rectal cancer bleeding in pts who have already had surgery to treat their cancer. ## Complications That May Arise After Proctoscopy: - Heavy blood loss after the examination. - Difficulty in urinating - Heavy pain ## NB: - Dietary restrictions are not usually necessary. - Sedation usually is not required. # Endoscopy Final Revision ## Cystoscopy: - Cystoscopy also known as uretero-renoscopy (URS) used to examine the inside of the bladder and urethra. - It is performed using a thin, tube-like instrument called cystoscopy, that views detailed images of the urinary tract on a screen. - **NB:** Is the examination of the inside of the bladder. ## Indication for Cystoscopy: - You routine examination of the urinary bladder - Biopsy of a tumor - Cystogram for diagnostic X-rays - Evaluation/ removal of obstructions in the genitourinary tract. - Bladder neck incision by observation. - Coagulation of hemangioma - Removal of a foreign body - Hematuria - Frequent cystitis - Other urinary tract infections - Urinary retention - Calculi (stone) discovered on accidental X-ray. ## Catheterige the Ureters: - To treat lesions or tumors - To follow up the examination - Operative or endoscopic ## Contraindications: - Active urinary tract infection - Severe urethral stricture - Acute prostatitis - Severe coagulopathy or blood disorders. - Recent bladder or urethral disease - Severe cardiorespiratory - Pregnancy - Pelvic radiation history ## Types of Cystoscopy: - Rigid cystoscopy - Flexible cystoscopy ## Uretroscope - An instrument for examining the urinary tract. - Also known as Ureter Renoscopy (URS) is a examination of the upper urinary tract, and renal pelvis and calyx